# MEDIVEST DENTON, LP

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Monticello Diagnostic Imaging of Decatur
- **Organization subpart:** No

## Provider details

- **NPI number:** 1578214284
- **Authorized official:** CHELSEA MECHELLE HOLDER (PRACTICE ADMINISTRATOR)
- **Authorized official phone:** (817) 377-3800

## Contact information

- **Practice address:** 1713 S FM 51 \# 104, DECATUR, TX 76234-3642
- **Practice address phone:** (817) 377-3800
- **Practice address fax:** (817) 377-3801
- **Mailing address:** 3712 W 7TH ST, FORT WORTH, TX 76107-2536
- **Mailing address phone:** (817) 202-5179
- **Mailing address fax:** (817) 377-3801

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 2085R0202X | Diagnostic Radiology Physician | — | NULL | — |
| 2085R0202X | Diagnostic Radiology Physician | — | — | — |
| 261QR0200X | Radiology Clinic/Center | — | NULL | Yes |
| 293D00000X | Physiological Laboratory | — | NULL | — |

## Other

- **Enumeration date:** 01/13/2022
- **Last updated:** 12/27/2024